免疫力のある重症患者のサイトメガロウイルス再活性化
Ajit P Limaye1, Katharine A Kirby, Gordon D Rubenfeld
1Department of Laboratory Medicine, University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195-7110, USA. limaye@u.washington.edu
JAMA
|July 24, 2008
まとめ
サイトメガロウイルス (CMV) の再活性化は,重症で免疫力のある患者で一般的であり,より長い入院や死亡に関連しています. CMV予防に関するさらなる研究が推奨されています.
科学分野:
- クリティカルケア・メディシン
- 感染症 感染症は感染症です.
- ウイルス学 ウイルス学 ウイルス学
背景:
- サイトメガロウイルス (CMV) 感染症は,免疫抑制状態の個人にリスクをもたらす.
- 重症で免疫力のある患者のCMV再活性化の発生率と影響は不明である.
研究 の 目的:
- サイトメガロウイルス (CMV) 再活性化と集中治療室 (ICU) と病院での滞在期間との関連を調査する.
- 重症で免疫能力のある個体におけるCMV再活性化と有害な結果との関係を評価する.
主な方法:
- ICUに収容されている120人のCMV陽性で免疫能力のある成人を対象とした前向きな研究.
- リアルタイムポリメラーゼ連鎖反応 (PCR) を用いて週3回のCMVプラズマDNAアミア評価.
- 臨床的結果と滞在期間は,盲目のスタッフによって監視されました.
主要な成果:
- CMVウイルス性ウィレミアは33%の患者で,高レベルのウイルス性ウィレミア (>1000コピー/mL) は20%で発生しました.
- CMV再活性化は,30日以内に入院または死亡と独立して関連していました (調整されたOR,4.3-13.9).
- CMVレベルは,長期の入院 (≥14日) (調整されたOR,3.2-5.1) と関連していました.
結論:
- CMV再活性化は,重症で免疫力のある患者で頻繁に見られます.
- 再活性化は,入院期間と死亡率の増加と関連しています.
- この患者グループにおけるCMV予防のための制御試験は正当である.
関連する概念動画
Hypersensitivity Reactions: Cytolytic Reactions
Type II hypersensitivity involves IgG and IgM antibodies targeting cell surface antigens, leading to cell destruction. This can occur through complement activation, antibody-dependent cell-mediated cytotoxicity (ADCC), or acting as opsonins for phagocytosis. When excessive, these reactions cause significant tissue damage.Drug-induced hemolytic anemia is a common example, where drugs like penicillin or cephalosporins bind to red blood cells, forming drug-protein complexes. These complexes...
Myocarditis III: Medical Management
Myocarditis: Comprehensive Medical ManagementMyocarditis, the heart muscle inflammation, requires a comprehensive medical management strategy that addresses the underlying cause, provides supportive care, manages symptoms, and reduces cardiac workload.Infections and Autoimmune CausesAdminister appropriate antimicrobial therapy when an infectious agent causes myocarditis. For instance, penicillin treats infections caused by Group A Streptococcus. In cases where autoimmune processes are...
Chickenpox
Chickenpox is an acute, highly contagious disease caused by the varicella-zoster virus (VZV), a double-stranded DNA virus belonging to the Herpesviridae family. Its transmission occurs primarily through the inhalation of respiratory droplets or direct contact with vesicular fluid from skin lesions. The incubation period typically ranges from 10 to 21 days, during which the virus replicates and disseminates through sequential phases within the host. Although generally self-limiting in children,...
Cytomegalovirus Disease
Cytomegalovirus (CMV) disease is caused by human cytomegalovirus, a double-stranded DNA virus of the Herpesviridae family. While primary CMV infection is often asymptomatic in immunocompetent individuals, the virus can cause severe disease in neonates and immunocompromised patients. CMV is the most common cause of congenital viral infection in the United States, and a major pathogen in solid organ and hematopoietic stem cell transplant recipients.CMV is transmitted via bodily fluids, sexual...
Respiratory Syncytial Virus Disease
Human respiratory syncytial virus (RSV) is a widespread pathogen that primarily targets infants and young children but also poses a serious health risk to elderly and immunocompromised individuals. Belonging to the Pneumoviridae family, RSV is a negative-sense, single-stranded RNA virus within the Pneumovirus genus. Its global health burden is significant, with millions of cases annually resulting in hospitalizations and mortality, particularly in resource-limited settings. Although most...
Cryptococcal Meningitis
Cryptococcal meningitis is a life-threatening opportunistic infection predominantly associated with HIV/AIDS, accounting for over 100,000 deaths annually worldwide. However, it also affects individuals with other forms of immunosuppression, including those undergoing immunosuppressive therapy, organ transplant recipients, patients with innate immunodeficiencies, and individuals with hematological disorders. The infection is caused mainly by Cryptococcus neoformans and Cryptococcus gattii,...


